icd 9 code for readmission algorithm

by Eladio Connelly 5 min read

What is a planned readmission?

1. Planned Readmission Algorithm Overview. Readmission measures are intended to capture unplanned readmissions that arise from acute clinical events requiring urgent re-hospitalization within 30 days of discharge. Generally, planned readmissions are not a signal of quality of care.

How do you calculate readmission?

Readmission rate: number of readmissions (numerator) divided by number of discharges (denominator); each readmission should be counted only once to avoid skewing the rate with multiple counts.

What are all cause readmissions?

The 30-day All-Cause Hospital Readmission measure is a risk-standardized readmission rate for beneficiaries age 65 or older who were hospitalized at a short-stay acute-care hospital and experienced an unplanned readmission for any cause to an acute care hospital within 30 days of discharge.

What is the 30-day readmission rule?

The HRRP 30-day risk standardized unplanned readmission measures include: Unplanned readmissions that happen within 30 days of discharge from the index (i.e., initial) admission. Patients who are readmitted to the same hospital, or another applicable acute care hospital for any reason.

How is all cause readmission rate calculated?

The Observed-to-Expected (O/E) ratio is the ratio of the count of actual (observed) readmissions in relation to the count of risk-adjusted (expected) readmissions. It is equal to the Count of Observed 30-Day Readmissions (Column 2) divided by the Count of Expected 30-Day Readmissions (Column 4).

What is readmission rate?

​ Definition. Percentage of admitted patients who return to the hospital within seven days of discharge. Goal. The percentage of admitted patients who return to the hospital within seven days of discharge will stay the same or decrease as changes are made to improve patient flow through the system.

How is hospital readmission defined?

A hospital readmission is an episode when a patient who had been discharged from a hospital is admitted again within a specified time interval. Readmission rates have increasingly been used as an outcome measure in health services research and as a quality benchmark for health systems.

What is an unplanned readmission?

Definition of unplanned readmissions The first hospitalization in 2007 was identified as the index hospitalization, and a 30-day unplanned readmission was defined as a subsequent or unscheduled admission to the same specialty through the Accident & Emergency Department within 30 days of the index hospitalization [28].

How is the 30-day readmission rate calculated?

The Observed Readmission Rate is the percentage of acute inpatient stays during the measurement year that were followed by an unplanned acute readmission for any diagnosis within 30 days. It is equal to the Count of 30-Day Readmissions (Column 2) divided by the Count of Index Hospital Stays (Column 1).

How do you write a readmission application?

But due to some domestic/official reasons for my parents, and the transport problem of my present college, I want to readmission to your college. And now I want to rejoin your college in the (class/grade name). I, therefore, pray and hope that you would kindly give permission for my re-admission.

What is a code 44 Medicare?

A Condition Code 44 is a billing code used when it is determined that a traditional Medicare patient does not meet medical necessity for an inpatient admission. An order to change the patient status from Inpatient to Observation (bill type 13x or 85x) MUST occur PRIOR TO DISCHARGE.

How are readmission penalties calculated?

The penalties were calculated by subtracting each adjustment factor from 1 and turning it into a percentage. Thus, a hospital losing the most money because of its high readmission rate (which CMS gave an adjustment factor of 0.97) is listed by KHN as receiving a 3 percent penalty.

What is the general population algorithm?

The General Population algorithm uses the flow chart (Figure PR1) and the versions of Tables PR1-PR4 designed for the general population to identify specific procedure categories and discharge diagnosis categories to classify readmissions as planned. As illustrated in the flow chart (Figure PR1), readmissions that include certain procedures (Table PR1) or are for certain diagnoses (Table PR2) are always considered planned. If the readmission does not include a procedure or diagnosis in Table PR1 or Table PR2 that is always considered planned, the algorithm checks whether the readmission has at least one procedure that is considered potentially planned (Table PR3). If the readmission has no procedures from Table PR3, the readmission is considered unplanned. Table PR3 includes 57 AHRQ procedure CCS categories from among 231 AHRQ procedure CCS categories and 11 individual ICD-9-CM procedure codes. Examples of potentially planned procedures are total hip replacement (Procedure CCS 153) and hernia repair (Procedure CCS 85). The analogous tables for the THA/TKA and stroke measures can be found in section 3 of this document.

What is readmission measure?

Readmission measures are intended to capture unplanned readmissions that arise from acute clinical events requiring urgent re-hospitalization within 30 days of discharge. Generally, planned readmissions are not a signal of quality of care. Therefore, the Centers for Medicare & Medicaid Services (CMS) have worked with experts in the medical community as well as other stakeholders to identify planned readmissions for procedures and treatments and not count them in readmission measures. Specifically, CMS contracted with Yale New Haven Health Services Corporation – Center for Outcomes Research and Evaluation (YNHHSC/CORE) to develop a “planned readmission algorithm” that can be used to identify planned readmissions across its readmission measures, and has applied the algorithm to each of its readmission measures. The algorithm is a set of criteria for classifying readmissions as planned or unplanned using Medicare claims. The algorithm identifies admissions that are typically planned and may occur within 30 days of discharge from the hospital.


Implementation of the International Statistical Classification of Disease and Related Health Problems, 10th Revision (ICD-10) coding system presents challenges for using administrative data.


ICD-10 coding algorithms were developed by “translation” of the ICD-9-CM codes constituting Deyo's (for Charlson comorbidities) and Elixhauser's coding algorithms and by physicians’ assessment of the face-validity of selected ICD-10 codes.


Among 56,585 patients in the ICD-9-CM data and 58,805 patients in the ICD-10 data, frequencies of the 17 Charlson comorbidities and the 30 Elixhauser comorbidities remained generally similar across algorithms.


These newly developed ICD-10 and ICD-9-CM comorbidity coding algorithms produce similar estimates of comorbidity prevalence in administrative data, and may outperform existing ICD-9-CM coding algorithms.

What is AHRQ QI?

AHRQ Quality Indicators (QIs) to generate results that are both accurate and actionable. AHRQ currently has software available to specify ICD-10 coded numerators and denominators for the PSIs. This software ensures a standard, trusted approach to quality measurement so more resources are available to support improvements in patient care. The AHRQ QI software uses readily available data, requiring only administrative data already collected and reported by hospitals in most States. Using administrative data for measurement promotes consistency when evaluating performance over time and across initiatives and reduces costs associated with data collection and reporting. The software is compatible with two commonly used platforms, SAS and Windows, and is updated on an annual basis. To learn more about the AHRQ QI software, visit

What is PSI 90?

The Patient Safety Indicator 90 (PSI 90) composite is the weighted average of the reliability-adjusted observed-to-expected ratios (indirect standardization of the smoothed rates) for 10 patient safety indicators. For more information on the all-payer version of the PSI 90 and the other patient safety indicators, visit

What is VBP in healthcare?

efficiency and cost reduction domain of the Hospital Value-Based Purchasing (VBP) Program. For more information about the hospital MSPB measure and resources, including detailed measure calculation methodology, see the MSPB page on the QualityNet website:

Is there a translation between ICd 9 and ICd 10?

Yes, there are instances where there is no translation between an ICD-9-CM code and an ICD-10 code. The “No Map” flag indicates there is no plausible translation from a code in one system to any code in the other system. For example, the following codes are marked “No Map”:

What is planned readmission?

A few specific, limited types of care are always considered planned (transplant surgery, maintenance chemotherapy/immunotherapy, rehabilitation); otherwise, a planned readmission is defined as a non-acute readmission for a scheduled procedure. Click to visit the most recent CMS guidance. Look in the Downloads Section and open “AMI, HF, PN, COPD and Stroke Readmission Updates” and then click on the most current update in the folder. Look at the table of contents to find the section describing planned readmissions and the types of procedures and diagnoses that should be present when a readmission is planned.

What is admission type?

Admission Type – Whether an admission is coded as an emergent or urgent admission, an elective, or one of the other codes, can make a big difference in determining if the incident (HAC or PSI) should be attributed to the hospital.